Hepatectomy
| Hepatectomy | |
|---|---|
| Intervention | |
| ICD-9-CM | 50.22-50.4 |
| MeSH | D006498 |
Hepatectomy is the surgical resection (removal of all or part) of the liver. While the term is often employed for the removal of the liver from a liver transplant donor, this article will focus on partial resections of hepatic tissue and hepatoportoenterostomy.
The first hepatectomies were reported by Dr. Ichio Honjo (1913–1987) of (Kyoto University) in 1949, and Dr. Jean-Louis Lortat-Jacob (1908–1992) of France in 1952. In the latter case, the patient was a 58-year-old woman diagnosed with colorectal cancer which had metastasized to the liver.
Most hepatectomies are performed for the treatment of hepatic neoplasms, both benign or malignant. Benign neoplasms include , hepatic hemangioma and focal nodular hyperplasia. The most common malignant neoplasms (cancers) of the liver are metastases; those arising from colorectal cancer are among the most common, and the most amenable to surgical resection. The most common primary malignant tumour of the liver is the . Hepatectomy may also be the procedure of choice to treat intrahepatic gallstones or parasitic cysts of the liver. Partial hepatectomies are also performed to remove a portion of a liver from a live donor for transplantation.
A hepatectomy is considered a major surgery done under general anesthesia. Access is accomplished by laparotomy, typically by a bilateral subcostal ("chevron") incision, possibly with midline extension (Calne or "Mercedes-Benz" incision). An anterior approach, one of the most innovative, is made simpler by the liver hanging maneuver. Hepatectomies may be anatomic, i.e. the lines of resection match the limits of one or more functional segments of the liver as defined by the Couinaud classification (cf. liver#Functional anatomy); or they may be non-anatomic, irregular or "wedge" hepatectomies. Anatomic resections are generally preferred because of the smaller risk of bleeding and biliary fistula; however, non-anatomic resections can be performed safely as well in selected cases.
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